Health insurance costs are expected to rise for Americans in 2026.
ACA subsidies may expire, increasing marketplace prices for middle and low-income households.
Here’s what to know about employer- and government-based health insurance coverage.
As 2025 comes to a close, Americans are decorating for the holidays and agonizing over which health insurance plan to choose.
The decisions are complex and personal, as enrollees think about which plans best fit their income and medical needs. And, regardless of whether they have private or public coverage, most households are budgeting for higher costs.
Here’s what to know about insurance plans, enrollment deadlines, and policy changes in the new year.
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When are the health insurance enrollment deadlines?
Most Americans have private, employer-sponsored health insurance or a government-based plan. Nearly all of these programs have active enrollment, meaning that people need to sign up for insurance every year — even if they don’t intend to switch providers.
For Affordable Care Act plans, the enrollment deadline was December 15, with some options to make changes until January 15 for a later coverage start date. The Medicare enrollment deadline for older Americans was December 7. Most coverage begins January 1.
Deadlines for employer-based plans vary, but open enrollment tends to start November 1 and close in late November or early December, with coverage beginning on January 1.
Once Americans select their 2026 healthcare plan, they generally aren’t able to change their coverage until the next open enrollment cycle. Missing open enrollment means you will need to wait until next year to sign up for insurance.
People with qualifying life events, however, can adjust their plan if they file necessary paperwork with the government or their employer at any time throughout the year. Qualifying life events include a marriage, divorce, new baby, move, job loss, or major change of income.
Medicaid rules are different from other insurance plans because it is income based. Americans can enroll in the program on a rolling basis throughout the year if they meet the qualifying criteria.
How are Medicare and Medicaid different?
Both Medicare and Medicaid are government-based health insurance plans, though they serve different demographics.
Medicare is typically for Americans age 65 and older, many of whom also receive Social Security — though some people with disabilities are also eligible. The program has four main plan types: Parts A and Part B are standalone insurance that cover inpatient and outpatient care; Medicare Advantage allows older Americans to join private plans governed by Medicare rules and out-of-pocket caps; and Part D is supplemental insurance that covers prescription drugs and basic provider visits.
Medicaid is federally-funded health insurance for low-income households. The qualification threshold varies slightly by state, but tends to be based on the poverty line — which is $32,150 for a family of four. Most states have cutoffs between 138% and 260% of that level. These plans typically cover preventative visits, inpatient and outpatient care, and prescription drugs.
It’s possible for low-income older adults to enroll in Medicare and Medicaid at the same time.
Some families and pregnant women who earn above the Medicaid threshold but not enough for private insurance can also enroll in The Children’s Health Insurance Program (CHIP). The requirements are different in every state, but are usually between 170% and 400% of the federal poverty line.
Does marketplace insurance have income limits?
There are no income limits to enroll in marketplace insurance.
Income does come into play when deciding whether or not enrollees will receive tax credits that make their marketplace coverage more affordable. Between 2021 and 2025, Americans had access to enhanced Affordable Care Act subsidies. These credits lowered care and premium costs for low- and middle-income households based on their proximity to the federal poverty line.
Marketplace insurance will still be available to Americans regardless of income in 2026, though it’s likely that Congress will not extend the subsidies beyond their December 31 expiration date. Republican and Democratic senators are meeting this week to discuss the issue and plan to make a final announcement before they leave office on December 18. If the subsidies aren’t renewed, it could make the cost of marketplace insurance skyrocket for many low- and middle-income enrollees and some may be priced out of coverage.
What are EPO, PPO, and HMO plans?
EPO plans are often the cheapest option for private coverage, with low or nonexistent premiums. Americans may choose this coverage because it’s more affordable to maintain, though the plans tend to be restrictive about care. Enrollees are required to see only in-network providers and may also need to seek in-network emergency care. If someone on an EPO plan sees an out-of-network provider or pharmacist, they’re likely to be fully responsible for cost out of pocket.
PPO plans have more flexibility but a higher price tag. The in-network coverage available to enrollees offers more doctor, clinic, and pharmacy options, and allows people to go out of network when needed. Though premiums are more expensive, these plans tend to be a better fit for Americans with chronic health conditions or ongoing prescription needs.
HMO plans usually have a low monthly premium, but enrollees are limited to in-network providers except in emergency situations. These plans are best for older Americans who need preventative care, but don’t have chronic conditions and rarely need to see a specialist. These plans are also common among older Americans with Medicare Advantage.
Americans aren’t able to change their health coverage between EPO, PPO, or HMO plans once open enrollment ends, except if they have a qualifying life event.
How will health insurance costs change in 2026?
Costs for both private and public health insurance are expected to rise in the new year. This is due to a combination of factors: ACA subsidies are set to expire for marketplace plans, President Donald Trump’s One Big Beautiful Bill Act is set to limit Medicaid funding, and the price of private health insurance is rising for companies — a burden that many are partially passing to employees.
Though actual cost changes will vary widely, it’s likely that Americans will experience higher premiums and deductibles for care going forward.
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